Professional Documents
Culture Documents
Abstract
Background: Veneer restorations provide a valid conservative alternative to complete coverage as they avoid aggressive
dental preparation; thus, maintaining tooth structure. Initially, laminates were placed on the unprepared tooth surface. Although
there is as yet no consensus as to whether or not teeth should be prepared for laminate veneers, currently, more conservative
preparations have been advocated. Because of their esthetic appeal, biocompatibility and adherence to the physiology of
minimal-invasive dentistry, porcelain laminate veneers have now become a restoration of choice. Currently, there is a lack
of clinical consensus regarding the type of design preferred for laminates. Widely varying survival rates and methods for its
estimation have been reported for porcelain veneers over approximately 210 years. Relatively few studies have been reported
in the literature that use survival estimates, which allow for valid study comparisons between the types of preparation designs
used. No survival analysis has been undertaken for the designs used. The purpose of this article is to attempt to review the
survival rates of veneers based on different incisal preparation designs from both clinical and non-clinical studies.
Aims and Objectives: The purpose of this study is to review both clinical and non-clinical studies to determine the survival
rates of veneers based on different incisal preparation designs. A further objective of the study is to understand which is the
most successful design in terms of preparation.
Materials and Methods: This study evaluated the existing literature survival rates of veneers based on incisal preparation
designs. The search strategy involved MEDLINE, BITTORRENT and other databases.
Statistical Analysis: Data were tabulated. Because of variability in the follow-up period in different studies, the follow-up
period was extrapolated to 10 years in common for all of them. Accordingly, the failure rate was then estimated and The
weighted mean was computed.
Conclusions: The study found that the window preparation was of the most conservative type. Incisal coverage was better
than no incisal coverage and, in incisal coverage, two predictable designs incisal overlap and butt were reported. In butt
preparation, no long-term follow-up studies have been performed as yet. In general, incisal overlap was preferred for healthy
normal tooth with sufficient thickness and incisal butt preparation was preferred for worn tooth and fractured teeth.
Keywords: Feather edge; preparation; survival rates; veneers; window Articles selected were both clinical and non-clinical studies
INTRODUCTION
Advancements in the field of adhesive dentistry and
porcelain technology have broadened the use of porcelain
veneer restorations significantly. These original fragile
restorations, introduced by Dr. Charles Pincuss in 1938,
have undergone considerable improvement and refinement
over the past few decades, and have now matured into
a predictable restorative concept in terms of longevity,
periodontal response and patient satisfaction.[1]
These veneer restorations provide a valid conservative
alternative to complete coverage as they avoid aggressive
Website:
www.jcd.org.in
DOI:
10.4103/0972-0707.80723
10
Statistical analysis
Data were tabulated. Because of variability in the followup period in different studies, the follow-up period was
extrapolated to 10 years in common foe all the studies.
Accordingly, the failure rate was then estimated and the
weighted mean was computed [Tables 16, Figure 1].
DISCUSSION
The demand for treatment of unesthetic teeth is steadily
growing. Accordingly, several treatment options have been
proposed to restore the esthetic appearance of teeth, like
full-coverage crowns and bonding with composites. While
full-coverage crowns is highly invasive and may have an
adverse effect on the pulp or periodontal tissue, bonding with
composites on the other hand, even though less invasive,
continues to remain susceptible to discoloration, wear and
marginal fractures.[6] The search for a better alternative led
to the development of porcelain laminate veneers. These
ultrathin ceramic restorations were reported to provide a
superior alternative to direct composite resin bonding for
esthetic modification of teeth.[27] Porcelain laminate veneers
No. of veneers
372
115
43
183
Porcelain
Adhesive
Follow-up
Vitadur
Cerinate
Chameleon
Cerinate
Vita/Adh
Ultrabond
Ultrabond
Ultrabond
50
7
0
6
6.5 years
710 years
3 years
12190 months
11
No. of veneers
291
59
315
Porcelain
Adhesive
Failure rate
Cerinate
Ultra bond
Ceramco cariologic/ceramco bonding Ceramco
96
Follow-up
1.7% #
1842 months
No failures
48 months
17% failed out of 32% 63 months
No. of veneers
Porcelain
Adhesive
Failure rate
Follow-up
3 years
2 years
57 years
0.5 years
1.5 years
2.5 years
4 years
Christensen
Rucker[18]
Smales[8]
Chen[19]
163
44
64
546
Cerinate
Vitadur
Mirage/chameleon feldspathic
Cerinate
Ultrabond
Heliolink/vivadent
Ultrabond
Tenure
18%
0%
15%
1%
Jordan[20]
80
Den mat
Ultrabond
Christensen[17]
Nordbo[4]
165
135
Cerinate
Ceramco
3% failure, marginal
discrepancy 17%
13%
<3%*
[17]
3 years
3 years
No. of veneers
Porcelain
Adhesive
Failure rate
Follow-up
56 years
17 years
23 years
Peumans
Jager[23]
Calamia[24]
87
80
72
Gc cosmotech
Mirage flc
Chameleon
Scotch bond-2
Mirage bond
Ultra bond
Gilmore[25]
Kihn[15]
200
59
Chameleon-terec
Ceramco cariologic
Aristidis,Dimitra[2]
Sieweke[26]
Magne[1]
Fradeni[3]
186
36
48
83
Ceramco
Ips empress
Kreation
Ips empress
Duo-core-terec
Ceramco cariologic
bonding system
Variolink
Duozem
Herculite
Syntac
7%
1%
4.1% #-failure rate
15%-marginal
discoloration
Not significant
2 failuers noted at
incisal edge
1.6%
24%
0%
1%
Porcelain
Adhesive
Failure rate
Follow-up
Gc cosmotech
Mirage flc
Chameleon
Scotch bond-2
Mirage bond
Ultra bond
7%
1%
4.1% #-failure
rate 15%-marginal
discoloration
56 years
17 years
23 years
[21,22]
130 months
48 months
5 years
16.5 years
4.5 years
16 years
No. of veneers
Peumans[21,22]
Jager[23]
Calamia[24]
87
80
72
Table 6: Percentage of failure rates of laminates with analysis of data from non-clinical studies
Author
Year
Type of study
Highton
Hui[29]
Magne[30]
Hann[5]
Castelnuovo[31]
Seymour[32]
Hekimogulu[12]
Zarone[33]
Stappert[34]
[28]
1987
1991
1999
2000
2000
2001
2004
2005
2005
Photoelastic
Stress
2D FEM
Stress
Stress
Stress
Microleakae
3D FEM
Stress
Incisal overlap
Butt margin
Feather edge
*
*
*
*
*
*
*
*
*
*Type of preparation
12
Failure
10%
Survival rate
90%
Figure 1: Survival rate and failure rate for incisal bevel preparation veneers. Common follow-up period of 10 years. The
total number of veneers was 114
Window preparation
This preparation was suggested by Grabber and others,
13
No preparation
Here, the veneer is directly bonded on to the unprepared
tooth surface.
Statistical analysis of the data available revealed a high
failure rate of 56% with this design. The common modes
of failure seen were debonding and fracture. Lack of tooth
preparation was one of the major factors for high failure
rates of 56%.[10]
The reason attributed for this was that stress concentration
is less intense within restoration fitted to the prepared
teeth.[28,37] Further, surface preparation increases the bond
strength as it increases the surface area and removes the
aprismatic layer that is resistant to acid etching. Also,
preparing the tooth helps for a positive seat. Bonding allows
restoration to act as an integral part of the tooth structure.
The intimate contact allows better stress distribution and
prevents local overloading of brittle material. Factors that
influence the bond may effect the long-term and shortterm survival rates.[16]
14
12.
13.
14.
15.
16.
19.
CONCLUSIONS
REFERENCES
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
18.
20.
21.
22.
23.
1.
17.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
15
Copyright of Journal of Conservative Dentistry is the property of Medknow Publications & Media Pvt. Ltd. and
its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.